Showing posts with label MWAS. Show all posts
Showing posts with label MWAS. Show all posts
Friday, October 15, 2010
Seriously, I wanna know...
Who do your children consult for minor medical problems? Who "doctors" the scratches, sniffles, and bug bites?
Thursday, September 9, 2010
Seriously, I wanna know....
Is there a dress code for primary care physicians?
Some back story... a new drug rep came into my pediatric office to promote the latest asthma inhaler. I can't remember the name of the drug because she I was preoccupied with her purple maxi dress. Floor length knit dresses seem kind of appealing - comfortable, cover up all manner of figure flaws, easy to move in (until they get caught in the wheels of my rolling stool) and no ironing, but are they appropriate attire for a pediatrician?
Some back story... a new drug rep came into my pediatric office to promote the latest asthma inhaler. I can't remember the name of the drug because she I was preoccupied with her purple maxi dress. Floor length knit dresses seem kind of appealing - comfortable, cover up all manner of figure flaws, easy to move in (until they get caught in the wheels of my rolling stool) and no ironing, but are they appropriate attire for a pediatrician?
Thursday, October 8, 2009
Friday, September 11, 2009
Teachable Moments - do they come with a glass of Merlot?
“Mom,” Will says, “Harry carved his initials into the neighbor’s front door.”
Angel: He did what?!? No, it can’t be. That door is made of METAL.
Devil: That’s my boy! Metal, Schmetal.
Angel: How could my sweet, cherubic Harry do such a thing?
Devil: Hmpf! My cousin, Grover, sits on his left shoulder and talks really loud.
Angel: Hush! You’re not helping over there.
Devil: Just let it go – boys will be boys.
Angel: Boys will be juvenile delinquents, too. You need to call his father.
Devil: That’s my boy! Metal, Schmetal.
Angel: How could my sweet, cherubic Harry do such a thing?
Devil: Hmpf! My cousin, Grover, sits on his left shoulder and talks really loud.
Angel: Hush! You’re not helping over there.
Devil: Just let it go – boys will be boys.
Angel: Boys will be juvenile delinquents, too. You need to call his father.
“But, it’s a steel fire door. Have you seen it?”
“No, not yet, but he did it with a pocket knife.”
“Well, I think an immediate apology is in order.”
Devil: Oooooh! Now you’ve gone and done it.
Angel: He needs to apologize and offer to repair it.
Devil: Yeah. Can you imagine an eight year old repairing a front door?
Angel: OK, then he needs to pay for the damages.
Devil: You mean you need to pay for his damages.
Angel: Whatever. This is a teachable moment, and he needs to learn from his misstep. Besides, they’re trying to sell their house. Who’s going to buy it when they think their neighbors are a bunch of vandals?
Devil: You’ll never get him in the car.
Angel: Wanna bet?
Devil: I’m always willing to make a deal.
“Hello, Haley? Harry and I need to apologize for your door.”
Devil: Are you happy? You made him cry in front of the neighbor.
Angel: I know. I know. I feel like dirt. Parenting with a conscience is hard work. WWMW MD.D? (What would Marcus Welby, MD, do?)
Devil: Like Haley, I told you to just let it go. She has two boys, too. She understands. It’s just creative expression.
Angel: Well that creative expression goes by the name of vandalism, too.
Devil: Killjoy!
Angel: Just wait until his father gets home.
Angel: I know. I know. I feel like dirt. Parenting with a conscience is hard work. WWMW MD.D? (What would Marcus Welby, MD, do?)
Devil: Like Haley, I told you to just let it go. She has two boys, too. She understands. It’s just creative expression.
Angel: Well that creative expression goes by the name of vandalism, too.
Devil: Killjoy!
Angel: Just wait until his father gets home.
image from google image
Thursday, July 23, 2009
Seriously, I wanna know...
Sally: I'm difficult.
Harry: You're challenging.
Sally: I'm too structured. I'm completely closed off.
Harry: But in a good way.
When Harry Met Sally (1989)
Are you a magnet for difficult patients? By difficult, I mean patients with threatening or abrasive personalities, who come to the physician encounter with 5 or more complaints, use health services extensively, or have a mental disorder - the criteria used by Dr. An, et al in Burden of Difficult Encounters in Primary Care: Data from the Minimizing Error, Maximizing Outcomes Study. Archives of Internal Medicine 2009; 169(4): 410-414. According to their data, if you are young and female, you are more likely to have encounters with difficult patients. Is burnout responsible? What about multi-tasking? Does our training leave us prepared to deal with medically complex patients but not emotionally, demanding complex? Does the difficult encounter impact outcome?
Harry: You're challenging.
Sally: I'm too structured. I'm completely closed off.
Harry: But in a good way.
When Harry Met Sally (1989)
Are you a magnet for difficult patients? By difficult, I mean patients with threatening or abrasive personalities, who come to the physician encounter with 5 or more complaints, use health services extensively, or have a mental disorder - the criteria used by Dr. An, et al in Burden of Difficult Encounters in Primary Care: Data from the Minimizing Error, Maximizing Outcomes Study. Archives of Internal Medicine 2009; 169(4): 410-414. According to their data, if you are young and female, you are more likely to have encounters with difficult patients. Is burnout responsible? What about multi-tasking? Does our training leave us prepared to deal with medically complex patients but not emotionally, demanding complex? Does the difficult encounter impact outcome?
Tuesday, July 21, 2009
Day Dream Believer
After writing for Mothers in Medicine for a year, I took a short sabbatical from writing. It wasn’t planned or intentional. I have been carrying around this gnawing feeling that my kids are growing up so fast, and I need to spend whatever time I can eek out with them.
With six months of planning, I scheduled an extra day out of my office to spend with Will & Harry for the summer. I’m really liking my three day a week schedule, and I don’t think the extra day has put undue burden on my partners.
My fantasy about this summer with my sons was a glossy mirage of day trips to pick blueberries and find adventure together. As with most of my fantasies – going back to residency to do pediatric dermatology, starting a bead/jewelry company, surf lessons, decluttering my bonus room – reality has a way of smacking me between the eyes with either lack of skill, lack of time, or just lack of motivation.
So the score mid-summer for these idyllic trips:
Lovely Day trips with sons: 0
Loud action movies with popcorn/soda/candy in sedentary repose: 4
Afternoons spent with neighborhood boys running through my house: TMTK (too many to count)
On realization of the above score, I made the command decision last Thursday, to have an adventure and seek out our new IKEA store. (Can you hear the boos in the background? Sheesh, house wares, mom, what kind of adventure is that?) We set out for the twenty minute trek to the blue and yellow Mecca with promises (read bribes) of treats. So ninety minutes later, lost in 91 degree southeastern summer heat with limited AC in my station wagon, I discover that several “friends” have joined our trip:
Howie Mutch Longa
Tutantired Togo
Ima Lousie’n Mya Mynda (my BFF)
Dewie Hafta Ngo
Fortunately, bouncing on display beds and opening a myriad of drawers in the IKEA showroom once we found it disbanded our unhappy group of travelers. The strategic placement of the concession stand at the end of check-out taught me the power of Swedish Fish. And I have a plan to streamline our multipurpose bonus room – otherwise known as home office-guest room-exercise equipment storage-Lego & X Box central clearinghouse. I can also smile to myself when one of the boys starts a sentence “Remember the time mom dragged us to…” because I know time has a way of sugarcoating these memories as we age.
With six months of planning, I scheduled an extra day out of my office to spend with Will & Harry for the summer. I’m really liking my three day a week schedule, and I don’t think the extra day has put undue burden on my partners.
My fantasy about this summer with my sons was a glossy mirage of day trips to pick blueberries and find adventure together. As with most of my fantasies – going back to residency to do pediatric dermatology, starting a bead/jewelry company, surf lessons, decluttering my bonus room – reality has a way of smacking me between the eyes with either lack of skill, lack of time, or just lack of motivation.
So the score mid-summer for these idyllic trips:
Lovely Day trips with sons: 0
Loud action movies with popcorn/soda/candy in sedentary repose: 4
Afternoons spent with neighborhood boys running through my house: TMTK (too many to count)
On realization of the above score, I made the command decision last Thursday, to have an adventure and seek out our new IKEA store. (Can you hear the boos in the background? Sheesh, house wares, mom, what kind of adventure is that?) We set out for the twenty minute trek to the blue and yellow Mecca with promises (read bribes) of treats. So ninety minutes later, lost in 91 degree southeastern summer heat with limited AC in my station wagon, I discover that several “friends” have joined our trip:
Howie Mutch Longa
Tutantired Togo
Ima Lousie’n Mya Mynda (my BFF)
Dewie Hafta Ngo
Fortunately, bouncing on display beds and opening a myriad of drawers in the IKEA showroom once we found it disbanded our unhappy group of travelers. The strategic placement of the concession stand at the end of check-out taught me the power of Swedish Fish. And I have a plan to streamline our multipurpose bonus room – otherwise known as home office-guest room-exercise equipment storage-Lego & X Box central clearinghouse. I can also smile to myself when one of the boys starts a sentence “Remember the time mom dragged us to…” because I know time has a way of sugarcoating these memories as we age.
Friday, May 22, 2009
Seriously, I wanna know...
Over the past week, school systems across my state have administered tests that will determine for some children if they will advance to the next grade. This fourth quarter assessment causes no shortage of angst among the children of my community, and I have seen my fair share of nonspecific headaches and belly aches as a result. It makes me pause and wonder, are we teaching only one side of the anxiety equation? Some anxiety is helpful - it motivates, creates energy for us to act upon a situation. Like all things, though, there is a balance between the constructive state and the paralyzing fear of the unknown. Is there some sort of curiculum that we can use to instruct students about constructive ways to relax? Do you have favorite techiniques you use to guide your children and/or patients through nervousness?
Friday, May 8, 2009
Mother's Day
My oldest gifted me my mother's day gift a couple of days early. You can have one, too: http://news.cnnbcvideo.com/index2.html?p=jbj. We have a running joke about Mother of the Year awards and my credentials (or lack thereof) at my house. This was a perfect present from my IT-savvy son. At the beginning of the school year, each child in his middle school took possesion of a Macbook for the year. Technology in the hands of my children is an amazing thing....the websites, the comfort level of navigating the WWW, the animation and movies Will has made this year blow my mind.
Happy Mother's Day to all!
MWAS
Happy Mother's Day to all!
MWAS
Wednesday, May 6, 2009
MiM celebrates one year: MWAS
The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.
MWAS has been writing here from the beginning, sharing her stories of being a pediatrician in a private practice and being a mother of two tween boys. She writes:
Thank you, MWAS, for a wonderful year, and hopefully, more to come.
MWAS has been writing here from the beginning, sharing her stories of being a pediatrician in a private practice and being a mother of two tween boys. She writes:
MWAS also created the signature Seriously, I wanna know... posts where she throws out a pressing question on her mind to all of our readers. The one on keeping last name/changing name/hyphenating and the one on fiction recommendations got almost 30 comments each.When I went back and scanned my posts - the standouts were different than I expected - my writing has definitely changed over the year - which I love. I have a hard time just picking one favorite - Favorite things, 5 ways I know I'm not my mother at Christmas, & Bees and Birds are my selections.
Thank you, MWAS, for a wonderful year, and hopefully, more to come.
Monday, May 4, 2009
Membership
When I arrived at my office this morning, I had a walk-in patient waiting for me. In the winter months, it’s not unusual for a parent to try to “jump the line” and want to be seen first thing, and I try my best to accommodate parent and patient. I had promised to do a medicine re-check for my nurse’s child after I made morning hospital rounds today so that we could get her child to school, and my nurse back to work. My partner saw the walk-in who had stalked Lori, my scheduler, at the back door forty-five minutes prior to my arrival, while I saw my scheduled re-check.
Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.
Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.
The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.
Thursday, April 9, 2009
Mothering
Relationships with our mothers can be complicated, and mine is no exception. Our past 12 months have been challenging owing to illnesses, schedules and the 600 mile distance between our homes. Through the help of a wonderful therapist, I understand the dynamic between myself and my mother – intellectually – but the emotional part still struggles to keep up. The funny thing about therapy is that it helps me understand the past but not how to navigate aspects of the future.
For example, my father recently left me a message on Facebook (of all places!) that my mother was going to have a bone marrow biopsy for a chronically low platelet count. Based on fuzzy memories of my heme-onc rotations, bone marrow biopsy = cancer until proven otherwise. I google chronic thrombocytopenia looking for answers and a differential. That’s the default setting on my brain – back to logic & science & evidence. I also pick up the phone.
“Hi, Mom. How are you?”
“I’m fine. I’m supposed to have this test tomorrow in the hematologist’s office.”
From the tone of her voice, I can tell she’s on the verge of being unhinged by the test – not the potential diagnosis – although to her credit she’s been through early breast cancer (DCIS) & a course of radiation.
“Dr. Bone Marrow is very reassuring that the test is not a big deal.”
“Mom, you need to ask for Versed & lots of it.”
Flashback to standing at the bedside in the wards of the Navy Hospital. My face is hot as the blood is rushing to my toes in sympathy for the 6’5” man who is howling as the team of physicians are drilling into his pelvic bone. Flash back number two is in the OR with our heme-onc attending as they are putting his 8 year old patient with ALL to sleep. He readies the biopsy tray with classical music tinkling in the back ground.
“You don’t need to be pain.” (Thus my reason for being in therapy in the first place: the complicated dance of daughter nurturing mother. Once again the choreography takes off before I’ve even got my shoes on. )
“How do you spell that drug?” She asks.
“V-E-R-S-E-D.”
“OK, I’ll ask.”
She leaves me a message the next day thanking me. She and her doctor have decided to schedule the procedure in the interventional radiology suite with conscious sedation. She’s still somewhat unhinged by this. She wants to know more about conscious sedation. This time our exchange is mid-day by e-mail.
MWAS@gmail: It will be like your colonoscopy. Probably some Versed and monitoring.
MOM@gmail: OK. They have me scheduled for Friday with the radiologist.
MWAS@gmail: Talk to you later. Love you, Mom.
Post procedure was anti-climactic. She did well, and had glowing things to say for the radiologist and his nurse. With my father on the phone, some more piece of her puzzle slide into place. Mom’s been losing weight unintentionally for several months. She also has a low white cell count. She feels fine, otherwise. We all dance around the big C - and it leaves me wondering if that’s mom and dad’s doing or the doctors until they have a diagnosis. Intellectual mind whirrs through the differential: leukemia – maybe a chronic form like CML, viral infection (that’s the pediatrician in me), or some type of autoimmune problem like rheumatoid arthritis which runs in our family. There could be other reasons, but my adult medicine is rusty and inexperienced.
Emotional mind is reeling. Oh Crap! (and several other expletives) As much as I want just intellectual mind to deal with this, the therapy that’s trying hard to integrate the two aspects intervenes. I feel lost – not sure who is supposed to show up – the intellectual nurturer or the emotional daughter in need of her own nurturing but afraid to ask. To be continued….
For example, my father recently left me a message on Facebook (of all places!) that my mother was going to have a bone marrow biopsy for a chronically low platelet count. Based on fuzzy memories of my heme-onc rotations, bone marrow biopsy = cancer until proven otherwise. I google chronic thrombocytopenia looking for answers and a differential. That’s the default setting on my brain – back to logic & science & evidence. I also pick up the phone.
“Hi, Mom. How are you?”
“I’m fine. I’m supposed to have this test tomorrow in the hematologist’s office.”
From the tone of her voice, I can tell she’s on the verge of being unhinged by the test – not the potential diagnosis – although to her credit she’s been through early breast cancer (DCIS) & a course of radiation.
“Dr. Bone Marrow is very reassuring that the test is not a big deal.”
“Mom, you need to ask for Versed & lots of it.”
Flashback to standing at the bedside in the wards of the Navy Hospital. My face is hot as the blood is rushing to my toes in sympathy for the 6’5” man who is howling as the team of physicians are drilling into his pelvic bone. Flash back number two is in the OR with our heme-onc attending as they are putting his 8 year old patient with ALL to sleep. He readies the biopsy tray with classical music tinkling in the back ground.
“You don’t need to be pain.” (Thus my reason for being in therapy in the first place: the complicated dance of daughter nurturing mother. Once again the choreography takes off before I’ve even got my shoes on. )
“How do you spell that drug?” She asks.
“V-E-R-S-E-D.”
“OK, I’ll ask.”
She leaves me a message the next day thanking me. She and her doctor have decided to schedule the procedure in the interventional radiology suite with conscious sedation. She’s still somewhat unhinged by this. She wants to know more about conscious sedation. This time our exchange is mid-day by e-mail.
MWAS@gmail: It will be like your colonoscopy. Probably some Versed and monitoring.
MOM@gmail: OK. They have me scheduled for Friday with the radiologist.
MWAS@gmail: Talk to you later. Love you, Mom.
Post procedure was anti-climactic. She did well, and had glowing things to say for the radiologist and his nurse. With my father on the phone, some more piece of her puzzle slide into place. Mom’s been losing weight unintentionally for several months. She also has a low white cell count. She feels fine, otherwise. We all dance around the big C - and it leaves me wondering if that’s mom and dad’s doing or the doctors until they have a diagnosis. Intellectual mind whirrs through the differential: leukemia – maybe a chronic form like CML, viral infection (that’s the pediatrician in me), or some type of autoimmune problem like rheumatoid arthritis which runs in our family. There could be other reasons, but my adult medicine is rusty and inexperienced.
Emotional mind is reeling. Oh Crap! (and several other expletives) As much as I want just intellectual mind to deal with this, the therapy that’s trying hard to integrate the two aspects intervenes. I feel lost – not sure who is supposed to show up – the intellectual nurturer or the emotional daughter in need of her own nurturing but afraid to ask. To be continued….
Thursday, March 26, 2009
Seriously, I wanna know...
Do you have a favorite season? Does your favorite have anything to do with work/school? Winter for Pediatricians is like tax season for accountants - busy! In the spring, we are starting to pull out of cough, cold, flu season, but the days in the office can be unpredictable. Having just had a run of influenza at our house, I'd say home is unpredictable, too. Fall was my perennial favorite for many years - still some daylight when I left the office, boys in the groove of school, family vacation during Fall break. Our school system changed their schedule a few years back and did away with the Fall break - shattering it into several teacher work days scattered through the semester. Vacations shifted to Spring break to compensate. I've found myself looking forward to summer more and more - the more free-form home schedule, warm weather, flip flops (wish I could be OSHA compliant in them at work!) and lighter schedule at the office even with partners on time off. So my answer: Summer!
photo credit: seseo.wordpress.com/2009/01/
Wednesday, March 18, 2009
Pediatric Match Day
“Should I stay or should I go now?”
The Clash
I don’t think Mick Jones or Joe Strummer knew anything about the NRMP or National Resident Match Program – but their words echo in my head as I think about my journey from medical student to pediatric resident in the early 1990’s. The decisions I made that late winter were many but they boiled down to remaining in my medium sized southeastern hometown, or venturing to a bigger pond. St. Christopher’s in Philadelphia, Emory in Atlanta, Children's National Medical Center in Washington, DC were three of the several pediatric programs that I interviewed and interviewed me. The big city had an allure for me, and each successive site convinced me that I could swim in a bigger location.
But I had my doubts. Could I learn to draw all the labs on my admissions? Would that be educational or just scut? Would I be safe as I headed to my car after 30 hours (these were the pre-mandatory work hours days) in the hospital? Would the traffic overwhelm me? Could I afford to live on a resident’s salary? How would I find a roommate if I needed one? Did all the “perks” of a program really matter? Would I have chemistry with this program or that one? Maybe that seems like an odd question, but I was about to spend the majority or my life inside the walls of a hospital. I needed a sense of connection to this team I was about to join. For the next three years, I would be guided by physicians who could determine some part of my professional future with their advice and evaluations. In return, I would be expected to be a team-player with my fellow residents in the care of patients. Could all of this come down to a gut decision? For the one time in my life – footloose, unbeholden and young, my decisions affected only me.
Despite some early interests in triple board programs (Pediatrics/Psychiatry/Child & Adolescent Psychiatry), I interviewed in and ranked only categorical Pediatric programs. Writing that rank list was one of the hardest career moves I’ve had to make. (Taking my first job in the rural Southeast over the chief residency was a close second) All indications were that my home program at a children’s hospital would welcome me into their fold.( Reassuring smiles & nods from attending physicians) No guarantees, though. That would be against the rules of the match. The alternative was to take a risk and rank St. Christopher’s Hospital in Philadelphia number one – a program where I’d had a second interview and hopefully made an impression. Again. No guarantees. No assurances. Pick my home program and have familiarity and the acquaintance of at least two thirds of the residents. Or, pick the unfamiliar, riskier choice that could potentially jettison me into a fellowship or academic medicine.
My own Match Day was anti-climatic after I submitted my list. Most applicants for Pediatric residency positions get their first choice. I was no exception. Yet I was still jittery on that Wednesday. My class had spawned five couples who were trying to match as couples. My nerves felt their anxiety and my own. What if some computer glitch matched me in Philadelphia or Washington, DC? Was the decision really about location or was it more about envisioning the future of my career? Was it about having a high-powered pediatric career or a more balanced life that included pediatrics? Guess what? I’m still working on that balance, and some days I have thoughts about the fellowships I could have applied for, but I wouldn’t have written that rank list any differently.
The Clash
I don’t think Mick Jones or Joe Strummer knew anything about the NRMP or National Resident Match Program – but their words echo in my head as I think about my journey from medical student to pediatric resident in the early 1990’s. The decisions I made that late winter were many but they boiled down to remaining in my medium sized southeastern hometown, or venturing to a bigger pond. St. Christopher’s in Philadelphia, Emory in Atlanta, Children's National Medical Center in Washington, DC were three of the several pediatric programs that I interviewed and interviewed me. The big city had an allure for me, and each successive site convinced me that I could swim in a bigger location.
But I had my doubts. Could I learn to draw all the labs on my admissions? Would that be educational or just scut? Would I be safe as I headed to my car after 30 hours (these were the pre-mandatory work hours days) in the hospital? Would the traffic overwhelm me? Could I afford to live on a resident’s salary? How would I find a roommate if I needed one? Did all the “perks” of a program really matter? Would I have chemistry with this program or that one? Maybe that seems like an odd question, but I was about to spend the majority or my life inside the walls of a hospital. I needed a sense of connection to this team I was about to join. For the next three years, I would be guided by physicians who could determine some part of my professional future with their advice and evaluations. In return, I would be expected to be a team-player with my fellow residents in the care of patients. Could all of this come down to a gut decision? For the one time in my life – footloose, unbeholden and young, my decisions affected only me.
Despite some early interests in triple board programs (Pediatrics/Psychiatry/Child & Adolescent Psychiatry), I interviewed in and ranked only categorical Pediatric programs. Writing that rank list was one of the hardest career moves I’ve had to make. (Taking my first job in the rural Southeast over the chief residency was a close second) All indications were that my home program at a children’s hospital would welcome me into their fold.( Reassuring smiles & nods from attending physicians) No guarantees, though. That would be against the rules of the match. The alternative was to take a risk and rank St. Christopher’s Hospital in Philadelphia number one – a program where I’d had a second interview and hopefully made an impression. Again. No guarantees. No assurances. Pick my home program and have familiarity and the acquaintance of at least two thirds of the residents. Or, pick the unfamiliar, riskier choice that could potentially jettison me into a fellowship or academic medicine.
My own Match Day was anti-climatic after I submitted my list. Most applicants for Pediatric residency positions get their first choice. I was no exception. Yet I was still jittery on that Wednesday. My class had spawned five couples who were trying to match as couples. My nerves felt their anxiety and my own. What if some computer glitch matched me in Philadelphia or Washington, DC? Was the decision really about location or was it more about envisioning the future of my career? Was it about having a high-powered pediatric career or a more balanced life that included pediatrics? Guess what? I’m still working on that balance, and some days I have thoughts about the fellowships I could have applied for, but I wouldn’t have written that rank list any differently.
Saturday, March 7, 2009
Favorite Things
For Rinda,
To the tune of "My Favorite Things" from The Sound of Music
Four month old giggles and nine month old babbles
Dermatology cases in which I like to dabble
E-prescribing program that I am now trying
These are a few of my favorite things
A parent who stops me in Target to say thank-you
Tough diagnosis and putting together the clues
Recognition from a preteen that I am connecting
These are a few of my favorite things
Coaching new parents and caring for preemies
Referrals from OBs who bring their kids to me
Hugs at the knees and scared children now smiling
These are a few of my favorite things
Insurance pratfalls
Noncompliance
When the ED calls
I simply remember my favorite things
And then I don’t feel so bad
Four month old giggles and nine month old babbles
Dermatology cases in which I like to dabble
E-prescribing program that I am now trying
These are a few of my favorite things
A parent who stops me in Target to say thank-you
Tough diagnosis and putting together the clues
Recognition from a preteen that I am connecting
These are a few of my favorite things
Coaching new parents and caring for preemies
Referrals from OBs who bring their kids to me
Hugs at the knees and scared children now smiling
These are a few of my favorite things
Insurance pratfalls
Noncompliance
When the ED calls
I simply remember my favorite things
And then I don’t feel so bad
Cross posted at momwithastethoscope.wordpress.com
Friday, February 20, 2009
Boy Perfume
“If your grandfather hadn’t worn it, you probably wouldn’t exist…”
My tween Eldest loves to use this Old Spice tag line. Like many things in his world, he’s just beginning to grasp the underlying meaning. Now youngest - age 8 - is starting to follow right behind. He came downstairs this weekend doused with his brother’s cologne.
“Whoa, Buddy. Have you been in your brother’s Old Spice?”
“Well. Maybe. “ Kind of hard to cover up an overdose of aftershave.
“A little goes a long way, ya know?”
“I like to smell good.”
“Maybe we need to get you some of your own.”
“Can we?” Sure, I think. I’ve got one I can’t get into the shower but needs it. Regularly. And I’ve got one who’d bathe in dad smell if I let him.
Smells are part of my life – they’re hard to escape in medicine. The good ones: The buttery sweet smell of a newborn that makes me ovulate on cue as KC puts it, my butter cream candle that puts me in that Zen place. The mediocre: hand sanitizer foam, plastic odor from IV tubing, syringes, and emesis basins. The stomach churners: toddler poop, third hand smoke, formaldehyde based wavicide we use to clean instruments (sends me straight back to anatomy lab), and the perennial vomit tang. A well trained nose can turn off all but the strongest smells.
At home, I have to remember to turn my olfactory sense back on – make a conscientious effort to take in the yummy clean smell of my youngest’s hair and even the pubertal funk of Eldest – pre-Old Spice. Do I really want to mess with the chemistry that goes straight to my amygdala? Cover it up with some commercial pheromone?
I wonder what I smell like to my kids. Will they get a whiff in their old age and suddenly have memories of their mom? Perfume is one thing I can rarely forgo – can go without makeup, like Fizzy, but cannot go without some sort of scent. My current favorite is Philosophy’s Grace – it’s like grown-up baby powder to me – soft, a little floral, and subtle.
So at Target, I buy Youngest a bottle of Old Spice. It’s better than some of the alternatives. We keep peace in the bathroom with separate bottles for each of my fellows. A little goes a long way.
Tuesday, February 17, 2009
Seriously, I wanna know....?
This month I was going to defer to the tried and true and ask about a historical figure you'd like to have dinner with, but...I'll save that for a future SIWK.
So, I wanna know: Have you ever had your life flash before your eyes? What were the circumstances? Who was with you? Are you different as a result of the experience? Can you describe it?
So, I wanna know: Have you ever had your life flash before your eyes? What were the circumstances? Who was with you? Are you different as a result of the experience? Can you describe it?
Wednesday, February 11, 2009
Athena
In Homer’s epic, The Odyssey, he introduces us to Mentor, a character to whom Odysseus leaves in charge of his household while Odysseus goes off to the Trojan War. Depending on which scholar you subscribe to, Mentor is not an entirely successful guardian. He allows courtiers to woo Odysseus’s wife, Penelope in his absence. It is the appearance of Athena, goddess of wisdom and war, who disguises herself as Mentor, who shakes some sense into Telemachus, Penelope’s son.
"And yet you did not know me, Pallas Athene, Daughter of Zeus, who [will] always stand by your side and guard you through all your adventures."1
Fast forward a few thousand years. What does mentor mean today? What does a mentor look like? I have asked myself those same questions many times – and not just in the past 36 hours as I’m trying to meet our Topic Day deadline. In my mind’s eye, a mentor is someone who’s a lot like me – maybe a little older, a couple more gray hairs, and a few more life experiences under her belt. This mentor has a similar job and balances life successfully between work and home. She has the same issues with being a breadwinner or weight gain or feminism or being a leader in a predominantly male hospital culture. In lazier moments, I can be a cc or carbon copy or her and just follow in her hard won footsteps. No need to reinvent the wheel here.
But that person doesn’t exist, at least, not in my world. Like Athena, my mentors have come in many guises and where I least expect them. Like you, I had assigned advisors, and I learned plenty of pearls from those people. Those advisors were wise and understanding. For me, though, my mentors have had additional almost familial qualities and seem extra invested in their advice. My partner in my first practice was a mentor although I didn’t know it at the time. Warren's keen sense of business acumen guided me through the first three years of life as a private practice pediatrician. At the time, his work holism drove me crazy especially on the day after Christmas when we saw seventy (70) patients each. His philosophy was we’d see “em, as long as they kept calling for appointments.
When I opened my own business, I realized what production really meant. It wasn’t just some fancy word for working your ass off – production pays the overhead and coasts my practice through lean summer schedules. Some days my office feels like a spin-off of my first practice especially the days I have to prod the other staff members to hustle. Warren also taught me to honor my community. The drycleaner who brings all seven children to my office for well child care gets my dry cleaning business in return. Giving back to the same community who supported him was a tenant that he lived by and that rubbed off on me, too. He even introduced me to my future husband. He was that invested in me and my career, and while he was too young to be a father figure, the mentor role suited him perfectly.
Other mentors are not so obvious. If you gave Dr. William Wilkoff my name, he would likely say “who?” I’ve never met the man, but each column he writes in Pediatric News is filled with anecdotes and common sense about his life as a pediatrician. Some are advice to the pediatrician like this Oct. 2003 article:
“As pediatricians for the new millennium, one of the many tasks for which we haven't been formally trained is to help parents learn to say no to their children. It may not have the ring of political correctness, but the health of our nation depends on it. Simply telling parents to “just say no” isn't enough. We must convince them that setting limits can be an important health issue by giving them the facts about obesity, accidents and a sedentary lifestyle. We must support parents by telling them that we understand why saying no can be difficult but that, when done properly, it is the right thing to do.” 2
Other columns comment on the demographic shift in pediatrics:
“Here in Brunswick, I have already been challenged by and benefited from the ramifications of this nationwide gender shift. My partners, Deb and Andrea, offer a perspective that teenage girls appreciate, and they project a warm and fuzzy image that appeals to the parents who find my no-nonsense style too hard edged. ”3
I love the practicalities Dr. Wilkoff discusses monthly. These are things I didn’t grasp in residency, and his warm and self-effacing manner focus on the art of medicine. He focuses on the science, too:
“Researchers recently discovered that there are two peaks for the termination of breast-feeding during the first 4 months post partum. The first occurs during the first week, when one-quarter of mothers stop breast-feeding. The investigators observed, “This timing suggests that a 1-week postpartum visit for well-child care is too late to intervene for many breast-feeding mothers” (Pediatrics 107[3]:543-48, 2001).
It's hard to make the handwriting on the wall any clearer. If we want to protect our patients from kernicterus, and if we truly believe that breast milk is the best first food for babies, then we all should be seeing our patients 2 or 3 days after hospital discharge.”4
The last piece of wisdom I’ve learned from all of these mentors is that my life is MY LIFE. Only I can navigate the path, and to carbon copy is cheating myself out of the opportunity to be a better, more balanced person. I don’t have to see 60 or 70 patients a day to be a good physician, but I need to be available at least 3 days a weeks to give my patients (& staff) some continuity. It’s what I do with their advice that matters, but they’re here for the long haul. I hope you find or have found that kind of support system – one that won’t let you carbon copy. Like Athena, it may be disguised and where you least expect it.
(1) Homer, The Odyssey: 210
(2) Wilkoff, William “‘No’ Problem “Pediatric News October 2003 (Vol. 37, Issue 10, Page 33)
(3) Wilkoff, William G.” The Feminization of Pediatrics” Pediatric News August 2002 (Vol. 36, Issue 8, Page 24)
(4) Wilkoff, William G.” Neonates Can’t Wait” Pediatric News; Volume 35, issue 12, Page 43 (December 2001)
"And yet you did not know me, Pallas Athene, Daughter of Zeus, who [will] always stand by your side and guard you through all your adventures."1
Fast forward a few thousand years. What does mentor mean today? What does a mentor look like? I have asked myself those same questions many times – and not just in the past 36 hours as I’m trying to meet our Topic Day deadline. In my mind’s eye, a mentor is someone who’s a lot like me – maybe a little older, a couple more gray hairs, and a few more life experiences under her belt. This mentor has a similar job and balances life successfully between work and home. She has the same issues with being a breadwinner or weight gain or feminism or being a leader in a predominantly male hospital culture. In lazier moments, I can be a cc or carbon copy or her and just follow in her hard won footsteps. No need to reinvent the wheel here.
But that person doesn’t exist, at least, not in my world. Like Athena, my mentors have come in many guises and where I least expect them. Like you, I had assigned advisors, and I learned plenty of pearls from those people. Those advisors were wise and understanding. For me, though, my mentors have had additional almost familial qualities and seem extra invested in their advice. My partner in my first practice was a mentor although I didn’t know it at the time. Warren's keen sense of business acumen guided me through the first three years of life as a private practice pediatrician. At the time, his work holism drove me crazy especially on the day after Christmas when we saw seventy (70) patients each. His philosophy was we’d see “em, as long as they kept calling for appointments.
When I opened my own business, I realized what production really meant. It wasn’t just some fancy word for working your ass off – production pays the overhead and coasts my practice through lean summer schedules. Some days my office feels like a spin-off of my first practice especially the days I have to prod the other staff members to hustle. Warren also taught me to honor my community. The drycleaner who brings all seven children to my office for well child care gets my dry cleaning business in return. Giving back to the same community who supported him was a tenant that he lived by and that rubbed off on me, too. He even introduced me to my future husband. He was that invested in me and my career, and while he was too young to be a father figure, the mentor role suited him perfectly.
Other mentors are not so obvious. If you gave Dr. William Wilkoff my name, he would likely say “who?” I’ve never met the man, but each column he writes in Pediatric News is filled with anecdotes and common sense about his life as a pediatrician. Some are advice to the pediatrician like this Oct. 2003 article:
“As pediatricians for the new millennium, one of the many tasks for which we haven't been formally trained is to help parents learn to say no to their children. It may not have the ring of political correctness, but the health of our nation depends on it. Simply telling parents to “just say no” isn't enough. We must convince them that setting limits can be an important health issue by giving them the facts about obesity, accidents and a sedentary lifestyle. We must support parents by telling them that we understand why saying no can be difficult but that, when done properly, it is the right thing to do.” 2
Other columns comment on the demographic shift in pediatrics:
“Here in Brunswick, I have already been challenged by and benefited from the ramifications of this nationwide gender shift. My partners, Deb and Andrea, offer a perspective that teenage girls appreciate, and they project a warm and fuzzy image that appeals to the parents who find my no-nonsense style too hard edged. ”3
I love the practicalities Dr. Wilkoff discusses monthly. These are things I didn’t grasp in residency, and his warm and self-effacing manner focus on the art of medicine. He focuses on the science, too:
“Researchers recently discovered that there are two peaks for the termination of breast-feeding during the first 4 months post partum. The first occurs during the first week, when one-quarter of mothers stop breast-feeding. The investigators observed, “This timing suggests that a 1-week postpartum visit for well-child care is too late to intervene for many breast-feeding mothers” (Pediatrics 107[3]:543-48, 2001).
It's hard to make the handwriting on the wall any clearer. If we want to protect our patients from kernicterus, and if we truly believe that breast milk is the best first food for babies, then we all should be seeing our patients 2 or 3 days after hospital discharge.”4
The last piece of wisdom I’ve learned from all of these mentors is that my life is MY LIFE. Only I can navigate the path, and to carbon copy is cheating myself out of the opportunity to be a better, more balanced person. I don’t have to see 60 or 70 patients a day to be a good physician, but I need to be available at least 3 days a weeks to give my patients (& staff) some continuity. It’s what I do with their advice that matters, but they’re here for the long haul. I hope you find or have found that kind of support system – one that won’t let you carbon copy. Like Athena, it may be disguised and where you least expect it.
(1) Homer, The Odyssey: 210
(2) Wilkoff, William “‘No’ Problem “Pediatric News October 2003 (Vol. 37, Issue 10, Page 33)
(3) Wilkoff, William G.” The Feminization of Pediatrics” Pediatric News August 2002 (Vol. 36, Issue 8, Page 24)
(4) Wilkoff, William G.” Neonates Can’t Wait” Pediatric News; Volume 35, issue 12, Page 43 (December 2001)
Friday, January 16, 2009
Membership
When I arrived at my office this morning, I had a walk-in patient waiting for me. In the winter months, it’s not unusual for a parent to try to “jump the line” and want to be seen first thing, and I try my best to accommodate parent and patient. I had promised to do a medicine re-check for my nurse’s child after I made morning hospital rounds today so that we could get her child to school, and my nurse back to work. My partner saw the walk-in who had stalked Lori, my scheduler, at the back door forty-five minutes prior to my arrival, while I saw my scheduled re-check.
Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.
Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.
The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.
Sometimes parents believe that medicine is a club – one that you can join if you have the right political affiliations or money or a very important job. Membership in this club gets them exclusive bonuses –kind of like frequent flyer miles or box tops – bonuses that include a physician’s home phone number or pager and the right to call them any time of day or night. Occasionally a parent will ask for my direct number- sometimes with a smile or a giggle as they promise not to call me at 2 AM for a diaper rash or spit-up. Acceptance into this club also allows members to talk about their child’s sex education in Starbucks, or ask for antibiotics (just in case) whenever they are leaving the country for Turks and Caicos for the next two weeks.
Being truthful with myself, I accept that I am part of a club of sorts. When my triage service calls about a family friend who bit his tongue and needed advice about whether to go to the ER or not, I call the family because they‘re friends, and they would show the same concern for my children. I’ve also referred my brother-in-law with appendicitis to Dr. Ileum because he’s a friend and I know he’ll take good care of my relative. I’ve also met a fellow partner and her child in the middle of the night when she suspected her daughter had new onset Type 1 diabetes. (She was right!) My family and close friends (I can count the number of families on one hand) are default members, and they know there are rules about membership.
The notion of an exclusive membership or concierge medicine doesn’t sit well with me. As humanly possible, I try to treat my patients as well and equally as I would treat my own family or friends regardless of socioeconomic status. There are boundaries, though, and limit pushers that make me put my foot down. I won’t write prescriptions on the fly for administrator or staff’s children anymore when I’m trying to make hospital rounds. It’s not fair to my patients to get distracted like that. I cannot prevent a patient with lice showing up on Sunday morning on my front porch, but I won’t let them expose my kids. My phone has caller ID, and we screen the calls heavily, so when I’m not on call, I’m focused on my family, and my personal time. It’s all part of a balancing act that I’ve had to learn bit by bit.
Saturday, January 3, 2009
Seriously, I wanna know...
Have you read any good fiction lately? Do you have time or the desire to read outside of your profession?
Tuesday, December 23, 2008
5 Ways I know I am Not My Mother at Christmas
1. Cookies: My mother made dozens of cookies when I grew up: pecan sandies coated in powdered sugar, gingerbread cutouts, spritz, bourbon balls, fruitcake cookies, “painted cookies” (sugar cookies with glossy egg wash in corresponding colors) just to name a few. What we did with all of these cookies, I really don’t remember. Maybe we gave some away. We ate some for dessert nightly. We left a few for Santa. While I enjoy cooking, and cooking with my sons can be a lot of fun, I just don’t do it much. My mom gave me an appreciation for homemade baked goods, and I love that holiday tradition. But the boys & I don’t need the temptation of baked butter and sugar close by – Pillsbury, Duncan Hines, or my own.
2. Carrying a pager on 12/25/08: I’m on call for my partners and myself this year. The upside is that only the sickest of the sick children’s parents call that day. I’ll make rounds in the morning, and my kids are understanding about my leaving for an hour or two.
3. Stuffing things in bags at the last minute: I believe I have perfected the wrap in tissue and shove in snowman bag much as a quarterback throws a perfect spiral. It’s all in the wrist. My mom’s method is to wrap and then add beautiful ribbons and bows and embellishments. It also requires sitting. My method can be done as I am striding to the car on the way to a recital or party.
4. Looking forward to mother-in-law’s Christmas day because I don’t have to cook (much): My mom is an amazing cook. My family tradition is an English Christmas dinner with roast beef, Yorkshire pudding, parsnips and potatoes, and gravy. It makes my mouth water just to type those words. We lived overseas when I was in grade school, and adopted this tradition. I’ve alluded to my ability to juggle cooking and call – just not able to do it. I’m very grateful to my in-laws that they host the family for a covered dish get together. My husband makes his popular meatballs (another Crockpot winner!)
5. The internet: I shop (thank you, Amazon). I keep up with life, and blog: Where would I be without the ability to find and ship gifts to multiple places? My mother spent hours going from store to store searching for the perfect gift, packing them, and hauling the box to the post office. I do some of that, but the internet has streamlined the process so that I can continue to work full-time (a Pediatrician’s busy season) through the months of November & December.
A year ago, I didn’t know what a blog was let alone had an idea I would be writing on one with such an amazing group of women. Thank you. Mothers in Medicine! Thanks, KC, for giving me a chance to voice my opinion. Happy Holidays to you and your families & I look forward to the New Year!
Crossposted on momwithastethoscope.wordpress.com
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